PROJECT SUMMARY Every day more people commit suicide than die from motor vehicle accidents in the US. The goal of the NIMH Zero Suicide Initiative is prevention of suicide among those being served by health care systems. The Joint Commission has mandated that hospitals reduce suicide in healthcare settings through the use of evidence- based screening and assessment. An essential element of this process is the development of rapid but effective evidence-based screeners for use in emergency rooms, crisis clinics, and other first responder facilities. Our Systematic Expert Risk Assessment of Suicide (SERAS?) is a neural-network-based decision support tool that replicates the critical thinking of experienced clinicians in weighing risk factors to prospectively assess an individual's near-term risk of suicide. Our Phase I project demonstrated that SERAS? provides the same concurrent and predictive validity as a full clinician-based Columbia Suicide Severity Rating Scale (CSSRS) when used in an emergency department setting, yet takes a fraction of the time. We have two goals in this Phase II application. Our first goal is to integrate SERASTM into the workflow of a new healthcare system electronic health record and to establish its acceptability and usability when it replaces current standard screeners. We expect that SERASTM will have good-to-excellent usability and will be readily accepted as being easy to use and useful. Our second goal is to move SERAS? to a large scale, full implementation across a healthcare system and pairing it with in-person or telehealth secondary assessments for those who screen at low to moderate risk. By implementing SERAS? into the standard clinical workflow of 4 hospitals out of a 20 hospital system in the Omaha, Nebraska region, and screening more than 100,000 adults with SERAS? we will examine whether there is a reduction in the incidence of suicide and suicide-related events in this system over a two-year period. This project, when complete will enable timely care; it will implement efficient and less costly healthcare delivery; it will enhance surveillance of individuals at risk within the healthcare system; and it will provide immediate decision support to the end user by identifying targeted interventions. We provide evidence for the commercial potential of SERAS? through a detailed commercialization plan that demonstrates that, even with relatively low levels of market penetration, this tool can become self-sustaining to allow for more evidence-based screens and more lives saved.